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Purpose Osteoporosis, the most prevalent metabolic bone disease, significantly impacts global public health by increasing fracture risks, particularly among post-menopausal women and the elderly. Osteoporosis is characterized by decreased bone mineral density (BMD) and deterioration of bone tissue, which leads to enhanced fragility. The disease is predominantly diagnosed using dual X-ray absorptiometry (DXA) and is significantly influenced by demographic factors such as age and hormonal changes. This chapter delves into the condition's complex nature, emphasizing the pervasive gender and racial disparities in its screening, diagnosis, and treatment. Recent Findings Recent findings highlight a substantial gap in the management of osteoporosis, with many individuals remaining under-screened and under-treated. Factors contributing to this include the asymptomatic early stages of the disease, lack of awareness, economic barriers, and inconsistent screening practices, especially in under-resourced areas. These challenges are compounded by disparities that affect different genders and races unevenly, influencing both the prevalence of the disease and the likelihood of receiving adequate healthcare services. Summary The summary of this chapter underscores the urgent need for targeted strategies to overcome these barriers and improve health equity in osteoporosis care. Proposed strategies include enhancing public and healthcare provider awareness of osteoporosis, broadening access to diagnostic screenings, and integrating personalized treatment approaches. These efforts aim to align with global health objectives to mitigate the impacts of osteoporosis and ensure equitable health outcomes across all demographic groups.

Backgrounds: Diet holds crucial significance in the management and prevention of type 2 diabetes. This study aims to compare dietary intake of key macronutrients and micronutrients across different race/ethnicity among adults with diabetes. Method: A cross-sectional analysis was conducted in 3,120 adults with diagnosed diabetes using the NHANES data from 2010 to March 2020. Type 2 diabetes was defined based on self-reported diagnosis or the use of anti-diabetic medications. Participants diagnosed with diabetes at age < 25years were assumed to have type 1 diabetes and were excluded. Race/ethnicity were categorized into White, Black, Asian, Mexican and other Hispanic adults. We compared the energy-adjusted nutrient intakes by race/ethnicity group and adjusted for sex and age. Results: There were significant differences in various nutrient intakes across race/ethnicity in adults with diabetes . Compared to White adults, Black adults were less likely to consume saturated fatty acids, calcium, zinc, and potassium; Asian adults had higher carbohydrate, fiber, magnesium, and sodium intakes but lower sugar, fat, saturated fatty acids, cholesterol, and calcium consumptions; Mexican adults had higher fiber and magnesium intakes but a lower sugar intake; other Hispanic adults had lower intakes of total fat, saturated fatty acids and monounsaturated fatty acids.(all p<0.01.) Conclusion: There were significant racial/ethnical differences in dietary intake among various racial and ethnic groups in the US population. Tailored approaches through racial and ethnic considerations may

Objectives There is preliminary evidence of racial and social economic disparities in the population infected by and dying from COVID-19. The goal of this study is to report the associations of COVID-19 with respect to race, health, and economic inequality in the United States. Methods We performed an ecological study of the associations between infection and mortality rate of COVID-19 and demographic, socioeconomic, and mobility variables from 369 counties (total population, 102,178,117 [median, 73,447; IQR, 30,761–256,098]) from the seven most affected states (Michigan, New York, New Jersey, Pennsylvania, California, Louisiana, Massachusetts). Results The risk factors for infection and mortality are different. Our analysis shows that counties with more diverse demographics, higher population, education, income levels, and lower disability rates were at a higher risk of COVID-19 infection. However, counties with higher proportion with disability and poverty rates had a higher death rate. African Americans were more vulnerable to COVID-19 than other ethnic groups (1981 African American infected cases versus 658 Whites per million). Data on mobility changes corroborate the impact of social distancing. Conclusion Our study provides evidence of racial, economic, and health inequality in the population infected by and dying from COVID-19. These observations might be due to the workforce of essential services, poverty, and access to care. Counties in more urban areas are probably better equipped at providing care. The lower rate of infection, but a higher death rate in counties with higher poverty and disability could be due to lower levels of mobility, but a higher rate of comorbidities and health care access.

This article reviews the literature on racism in medicine in the United States and reflects on the persistent barriers to diminishing racial biases in the U.S. health care system. Espoused strategies for decreasing racial disparities and reducing racial biases among physicians are critiqued, and recommendations are offered. Those recommendations include increasing the number of minority students in medical school, using Xavier University in New Orleans, Louisiana, as the model for medical school preparation; revamping the teaching of cultural competence; ensuring the quality of non-clinical staff; and reducing the risk of burnout among medical providers.

In the United States, the \"right to choose\" an abortion is the law of the land. But what if a woman continues her pregnancy because she didn't really have a choice? What if state laws, federal policies, stigma, and a host of other obstacles push that choice out of her reach?     Based on candid, in-depth interviews with women who considered but did not obtain an abortion, No Real Choice punctures the myth that American women have full autonomy over their reproductive choices. Focusing on the experiences of a predominantly Black and low-income group of women, sociologist Katrina Kimport finds that structural, cultural, and experiential factors can make choosing abortion impossible-especially for those who experience racism and class discrimination. From these conversations, we see the obstacles to \"choice\" these women face, such as bans on public insurance coverage of abortion and rampant antiabortion claims that abortion is harmful. Kimport's interviews reveal that even as activists fight to preserve Roe v. Wade, class and racial disparities have already curtailed many women's freedom of choice.   No Real Choice analyzes both the structural obstacles to abortion and the cultural ideologies that try to persuade women not to choose abortion. Told with care and sensitivity, No Real Choice gives voice to women whose experiences are often overlooked in debates on abortion, illustrating how real reproductive choice is denied, for whom, and at what cost. 

Using National Longitudinal Survey of Youth 1979 data on mid-life physical health, mental health, and self-esteem, I examine inter- and intra-racial disparities in health and well-being among veteran and non-veteran men (N = 2440). After controlling for selectivity into the military via propensity weighting, I find that black veterans have higher self-esteem than white veterans and comparable black non-veterans, but white veterans have similar mid-life self-esteem as their non-veteran counterparts. I find no evidence of disparities in health for depressive symptoms and self-rated health after taking selection into military service into account. The results suggest that aspects of military service may increase blacks' self-esteem, possibly due to less discrimination and more opportunity.

Recent literature reports inferior outcomes for patients of African ancestry (AA) who develop acute myeloid leukemia (AML). We herein present a cohort of 396 patients with 116 patients of AA (29%) who show inferior survival outcomes for patients of African ancestry ≥ 60 years (p =  0.008). Our cohort also demonstrated significantly increased rates of monosomy 7 and 7q deletions in the patients of AA ( p  = 0.04, p  = 0.03), suggesting association with genomic instability and loss of chromatin stabilization protein EZH2 , DNA repair function mediated by CUX1 , and SAMD9L anti-proliferation effect. Increased genomic instability may be mediated by accelerated aging related to environmental stressors or inherited genomic patterns. We also assessed the influence of neighborhood vulnerability. Patients of AA were more likely to live in census tracts with more people living below the 150% poverty level ( p  < 0.01). Undergoing allogeneic hematopoietic cellular transplant (allo-HCT) provided improved outcomes to patients of AA, highlighting the need to optimize access and supportive care for allo-HCT for minority patients. In multivariate analysis, race was not retained as an independent predictor of survival. Instead, adverse ELN22 risk and higher socioeconomic vulnerability scores were independently associated with inferior outcomes. These findings suggest that disparities in survival may be largely driven by the intersection of biological risk and social determinants of health, rather than ancestry itself acting as an independent prognostic factor.

Background Black/African American women with breast cancer have a disproportionately higher risk of mortality compared to other race groups, although their overall incidence of disease is lower. Despite this, advance care planning (ACP) and consequent code status documentation remain low in this vulnerable patient population. Code status orders (i.e., Full code, Do Not Attempt Resuscitation [DNAR], Do Not Intubate [DNI]) allow consideration of patient preferences regarding the use of aggressive treatments, such as cardiopulmonary resuscitation and intubation. The aim of this study is to characterize presence of code status orders and determine whether race affects code status documentation after the first encounter for breast cancer. Methods Data were derived from 7524 women with breast cancer from the University of Chicago Medical Center (UCMC) between 2016 and 2021. Cox regression was used to estimate the effects of race and adjusted for age, ethnicity, inpatient stays, metastatic breast cancer, marital status, and body mass index. Results The sample included 60.5% White, 3.6% Asian/Mideast Indian, 28.9% Black/African American, and 7.0% other or unknown race. Results indicate that code status orders after the first breast cancer encounter were uncommon (7.2%). Black/African American race (HR = 2.74; 95% CI: 1.75, 4.28) emerged as a significant factor associated with any code status orders compared to other race groups even when adjusting for covariates. Conclusions Code status documentation in this sample of women with breast cancer was low overall, yet rates were higher among Black/African American patients compared to other race groups. In fact, race remains a significant predictor of code status documentation even when accounting for indirect measures of cancer severity. This could be denoting the racial disparities (e.g., higher cancer malignancy such as triple negative breast cancer) in breast cancer mortality risk. Future research is needed to identify factors unique to Black/African American women that would increase code status documentation so that goal concordant care can be prioritized among patients with breast cancer.

Triple negative breast cancer (TNBC) is a molecularly heterogeneous disease whose incidence is disproportionately higher in African American (AA) women compared to European American (EA) women. Earlier onset, more advanced stage at diagnosis, and aggressive tumor phenotype are some of the characteristic features of TNBC in women with African ethnicity in comparison to EA women, denoting one of the most significant examples of racial disparity in oncology. It is still contentious whether health disparities result in aggressive behavior of TNBC in AA women or it is indeed a molecularly distinct disease. Given the “gaps-in-knowledge” surrounding racial disparity in TNBC, this review discusses various socioeconomic factors and the genetic predispositions contributing to poor prognosis of TNBC in AA women. While socioeconomic factors may contribute to poorer survival, multiple preclinical and clinical studies suggest inherent genetic risk factors and aberrant activation of oncogenic pathways in AA TNBC. Additionally, AA women are more likely to be obese and obesity is known to drive a molecular circuitry resulting in aggressive tumor progression indicating a potential obesity-TNBC axis at work in AA women. Given the multifactorial nature of AA TNBC, a transdisciplinary approach may help bridge the disparity that exists between AA and EA TNBC.

Vaccine uptake is critical for mitigating the impact of COVID-19 in the United States, but structural inequities pose a serious threat to progress. Racial disparities in vaccination persist despite the increased availability of vaccines. We ask what factors are associated with such disparities. We combine data from state, federal, and other sources to estimate the relationship between social determinants of health and racial disparities in COVID-19 vaccinations at the county level. Analyzing vaccination data from 19 April 2021, when nearly half of the US adult population was at least partially vaccinated, we find associations between racial disparities in COVID-19 vaccination and median income (negative), disparity in high school education (positive), and vote share for the Republican party in the 2020 presidential election (negative), while vaccine hesitancy is not related to disparities. We examine differences in associations for COVID-19 vaccine uptake as compared with influenza vaccine. Key differences include an amplified role for socioeconomic privilege factors and political ideology, reflective of the unique societal context in which the pandemic has unfolded.